# LAKESIDE EMS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside EMS LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093211823
- **Authorized official:** JERROD ESTES (CEO/PARAMEDIC)
- **Authorized official phone:** (217) 994-2046

## Contact information

- **Practice address:** 815 S MAPLE ST, EFFINGHAM, IL 62401-2641
- **Practice address phone:** (217) 994-2046
- **Practice address fax:** (724) 794-1633
- **Mailing address:** 815 S MAPLE ST, EFFINGHAM, IL 62401-2641
- **Mailing address phone:** (217) 994-2046
- **Mailing address fax:** (724) 794-1633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 060409935 | IL | Yes |

## Other

- **Enumeration date:** 04/02/2018
- **Last updated:** 08/09/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5219-01 | LICENSE NUMBER | IL |